2013 ACO Quality Measures

Transcription

1 ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating of Provider 4. Access to Specialist 5. Health Promotion and Education 6. Shared Decision Makin 7. Health Status/Functional Status ACO 8: Risk Standardized All Conditions Readmission Risk-adjusted percentage of ACO assigned beneficiaries who were hospitalized who were readmitted to a hospital within 30 days following discharge from the hospital for the index admission. ACO 9: Ambulatory Sensitive Conditions Admissions: COPD or ASTHMA in Older Adults All discharges with an ICD-9-CM principal diagnosis code for COPD or Asthma in adults ages 40 years and older, for ACO assigned or aligned Medicare fee-for-service (FFS) beneficiaries with COPD or Asthma, with risk-adjusted comparison of observed discharges to expected discharges for each ACO.1 This is a ratio of observed to expected discharges. ACO10: Ambulatory Sensitive Conditions Admissions: Heart Failure All discharges with an ICD-9-CM principal diagnosis code for HF in adults ages 18 years and older, for ACO assigned or aligned Medicare fee-for-service (FFS) beneficiaries with HF, with risk-adjusted comparison of observed discharges to expected discharges for each ACO.2 This is a ratio of observed to expected discharges. ACO11: Percent of Primary Care Physicians who successfully qualify for an EHR Program Incentive Payment. Percentage of Accountable Care Organization (ACO) primary care physicians (PCPs) who successfully qualify for either a Medicare or Medicaid Electronic Health Record (EHR) Incentive Program incentive payment. ACO 12: Medication Reconciliation Percentage of patients aged 65 years and older discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician providing on-going care who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented Page 1 of 5

2 ACO 13: Falls: Screening for Future Fall Risk Percentage of patients aged 65 years and older who were screened for future fall risk at least once within 12 months Fall - Is defined as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of a sudden onset of paralysis, epileptic seizure, or overwhelming external force. ACO 14: Preventive Care and Screening: Influenza Immunization Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization ACO 15: Preventive Care and Screening: Pneumonia Vaccination Percentage of patients aged 65 years and older who have ever received a pneumococcal vaccine ACO 16: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past six months or during the current visit Normal Parameters: Age 65 years and older BMI 23 and 30 Age years BMI 18.5 and 25 Definitions: BMI Body mass index (BMI) is expressed as weight/height (BMI; kg/m2) and is commonly used to classify weight categories. Calculated BMI Requires an eligible professional or their staff to measure both the height and weight. Self-reported values cannot be used. BMI is calculated either as weight in pounds divided by height in inches squared multiplied by 703, or as weight in kilograms divided by height in meters squared. Follow-up Plan Proposed outline of treatment to be conducted as a result of a BMI out of normal parameters. Such follow-up may include but is not limited to: documentation of a future appointment, education, referral (such as, a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, Section 4 Preventive Care 27 mental health professional or surgeon), pharmacological interventions, dietary supplements, exercise counseling or nutrition counseling. Page 2 of 5

3 ACO 17: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user Definitions: Tobacco Use Includes use of any type of tobacco. Cessation Counseling Intervention Includes brief counseling (3 minutes or less), and/or pharmacotherapy. ACO 18: Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Percentage of patients ages 12 and older screened for clinical depression using an age appropriate standardized tool AND if positive, a follow-up plan documented on the date of the positive screen ACO 19: Preventive Care and Screening: Colorectal Cancer Screening Percentage of patients aged 50 through 75 years who received the appropriate colorectal cancer screening ACO 20: Preventive Care and Screening: Breast Cancer Screening Percentage of women aged 40 through 69 years who had a mammogram to screen for breast cancer within 24 months ACO 21: Preventive Care and Screening: Screening for High Blood Pressure and Follow- Up Documented Percentage of patients aged 18 and older who are screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure reading as indicated ACO 22: Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: Hemoglobin A1c Control (< 8%) Percentage of patients ages 18 to 75 years of age with diabetes mellitus who had HbA1c < 8.0 percent ACO 23: Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control Control in Diabetes Mellitus Percentage of patients ages 18 to 75 years of age with diabetes mellitus who had LDL-C < 100 mg/dl Page 3 of 5

4 ACO 24: Composite (All or Nothing Score): Diabetes Mellitus: High Blood Pressure Control Percentage of patients ages 18 to 75 years of age with diabetes mellitus who had a blood pressure < 140/90 mmhg ACO 25: Composite (All of Nothing Scoring): Diabetes Mellitus: Tobacco Non Use Percentage of patients with a diagnosis of diabetes who indicated they were tobacco non-users ACO 26: Composite (All of Nothing Scoring): Diabetes Mellitus: Daily Aspirin or Antiplatelet Medication Use for Patients with Diabetes and Ischemic Vascular Disease Percentage of patients ages 18 to 75 years of age with diabetes mellitus and ischemic vascular disease with documented daily aspirin use during the measurement year unless contraindicated ACO 27: Diabetes Mellitus, Hemoglobin A1c Poor Control NQF #59; NCQA Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0% DENOMINATOR: Patients aged 18 through 75 years with the diagnosis of diabetes EXCLUDED FROM PERFORMANCE DENOMINATOR POPULATION: Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes NUMERATOR: Patients with most recent hemoglobin A1c level 9.0% ACO 28 Hypertension (HTN): Controlling High Blood Pressure Percentage of patients aged 18 through 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (< 140/90 mmhg) during the measurement year ACO 29: Ischemic Vascular Disease (IVD), Complete Lipid Profile and Low Density Lipoprotein (LDL-C) Control Percentage of patients aged 18 years and older with ischemic vascular disease (IVD) who received at least one lipid profile within 12 months and whose most recent LDL-C level was in control (less than 100 mg/dl) ACO 30: Ischemic Vascular Disease (IVD), Use of Aspirin or Another Antithrombotic Percentage of patients aged 18 years and older with ischemic vascular disease (IVD) with documented use of aspirin or other antithrombotic Page 4 of 5

5 ACO 31: Heart Failure: Use of Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge Definition: Prescribed Outpatient Setting: May include prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. Prescribed Inpatient Setting: May include prescription given to the patient for betablocker therapy at discharge OR beta-blocker therapy to be continued after discharge as documented in the discharge medication list. Beta-blocker Therapy for Patients with Prior LVEF 40% Should include bisoprolol, carvedilol, or sustained release metoprolol succinate. ACO 32: Composite (All of Nothing Scoring): Coronary Artery Disease (CAD), Lipid Control Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who have a LDL-C result < 100 mg/dl OR patients who have a LDL-C result >= 100 mg/dl and have a documented plan of care to achieve LDL-C < 100 mg/dl, including at a minimum the prescription of a statin ACO 33: Composite (All or Nothing Scoring): Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy Diabetes or Left Ventricular Systolic Dysfunction (LVEF <40%) Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy Page 5 of 5

Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both

Allscripts CQS Planning for 2014 Webinar: FAQs Listed below are questions asked by attendees based on the CQS Planning for 2014 Webinars, held on May 8, May 28, and May 30, 2014. Answers are provided below.

Welcome The AAMC, UHC and FPSC Web Conference on 2014 PQRS Proposed Changes will begin shortly. Please do not place your phones on hold. If you need to leave the event, hang up and dial back into the conference.

Technology Task Force Sample Request for Proposal This document has been created by the RBMA s Technology Task Force as a guideline for use by RBMA members working with potential suppliers of Electronic

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly

ABELMed EHR-EMR/PM version 12, an ONC HIT 2014 Edition Complete EHR, has been certified for the following 42 clinical quality measures (CQMs). The information contained in this document is also available

January 2012 Purpose of the Project The human and financial costs of cardiovascular disease are enormous. Heart disease is the leading cause of death for men and women in the United States and was estimated

Meaningful Use Are you considering purchasing an Electronic Health Record (EHR) or moving from your current vendor? Is your goal to attain Meaningful Use status in order to receive EHR incentive dollars?

Clinical Quality Measures for 2014 Mission of OFMQHIT To advance the implementation and use of vital health information technology to improve healthcare quality, efficiency and safety by assisting physician

Vermont ACO Shared Savings Program Quality Measures: Recommendations for Year 2 Measures from the VHCIP Quality and Performance Measures Work Group Presentation to VHCIP Steering Committee August 6, 2014

EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) An Introduction to the Medicare EHR Incentive Program for Eligible Professionals cms.gov/ehrincentiveprograms

On July 13, 2010, the Centers for Medicare & Medicaid Services (CMS) released the final rule defining meaningful use of an electronic health record (EHR) system. The original version of this rule was released

AAP Meaningful Use: Becoming a Meaningful User An Outpatient Checklist On July 13, 2010, the US Centers for Medicare and Medicaid Services (CMS) released a Final Rule establishing the criteria with which

Primary Care in the U.S. Measuring and Improving Primary Care in the United States ISQua Indicators Summit 2012 Cliff Fullerton, MD, MS VP Chronic Disease Baylor Health Care System Number of PCPs in the

Insurance the way we see it Accountable Care Organizations: Win-Win Collaboration Between Healthcare Payers and Provider Networks Table of Contents 1. Introduction 3 2. How HMOs and Provider Networks Can

Stage 1 Meaningful Use Criteria Physicians must meet all 15 Core Set objectives and measures and five of the 10 Menu Set objectives and measures. They also must report clinical quality measures (see separate

New Jersey Delivery System Reform Incentive Program The New Jersey Delivery System Reform Incentive Program (DSRIP) is part of New Jersey s Comprehensive Medicaid Waiver. The program provides incentive

CMS-1612-FC 848 M. Medicare Shared Savings Program Under section 1899 of the Act, CMS has established the Medicare Shared Savings program (Shared Savings Program) to facilitate coordination and cooperation

Understanding the CMS Final Rule "Meaningful Use" Requirements CME Course Announcements The Carolinas Center for Medical Excellence is accredited by the Accreditation Council for Continuing Medical Education

Medicare & Medicaid EHR Incentive Program Specifics of the Program for Eligible Professionals August 10, 2010 Today s Session This training will cover the following topics: EHR Incentive Programs a Background

EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) An Introduction to the Medicare EHR Incentive Program for Eligible Professionals cms.gov/ehrincentiveprograms

United States Government Accountability Office Report to the Ranking Member, Committee on Ways and Means, House of Representatives April 2015 MEDICARE Results from the First Two Years of the Pioneer Accountable

The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

2013 MEDICARE FEE-FOR-SERVICE QUALITY AND RESOURCE USE REPORT Sample Medical Practice Last Four Digits of Your Taxpayer Identification Number (TIN): 1530 ABOUT THIS REPORT FROM MEDICARE WHAT This Quality

12/15/2010 EMR Incentive Program for Eligible Professionals Topics for Today Meaningful Use Program Overview Who is eligible What is Meaningful Use (MU) How do you qualify How do you sign up How to determine

Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.

Practice Fusion 2014 Clinical Quality Measure Guide This guide will provide in depth information on the clinical quality measures that are available in Practice Fusion. WHAT ARE CLINICAL QUALITY MEASURES?

#1 Priority Measures Diabetes Medication Adherence D 3 69% 71% High Risk Meds in the Elderly D 3 8% 3% Sleep medications were added to the measure after the 2013 formulary was accepted. A number of high

MEASURING CARE QUALITY Region November 2015 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance

Medicare Shared Savings Program A Detailed Analysis of the Final Rule Health care is too important to stay the same. Executive Summary A more balanced program Few initiatives in recent history have cultivated

What to Expect in Next Year & Developing Your ACO Action Plan Welcome The webinar will start at 3:00 pm ET. It is interactive, so please make sure that you have connected via phone with your audio pin.

A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS The matrix below provides a comparison of all measures included in Medi-Cal P4P programs and the measures includes in DHCS s External Accountability